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  • commented 4/10/15
  • tags: CVS RAD WAG
  • Good article, but it's missing a key factor regarding low reimbursement rates. Pharmacy benefits managers (PBM) increase their margins through spread pricing, a process where the plan sponsor is over charged for a drug, the pharmacy is reimbursed a low rate and the PBM keeps what is left in the middle as profit. PBMs' cut of transactions can double drug costs for consumers or employers. A month's supply of a 20 milligram dose of Lipitor cost consumers or their employers $21.60, according to an audit of a PBM contract done by Pharmacy Outcomes Specialists, which represents companies, managed care organizations, unions and government agencies. The drugstore was reimbursed $10.83, so the PBM kept $10.77. [ less... ]
    Good article, but it's missing a key factor regarding low reimbursement rates. Pharmacy benefits managers (PBM) increase their margins through spread pricing, a process where the plan sponsor is over charged for a drug, the pharmacy is reimbursed a low rate and the PBM keeps what is left in the middle as profit. PBMs' cut of transactions can double drug costs for consumers or employers. A month's supply of a 20 milligram dose of Lipitor cost consumers or their employers $21.60, according to an audit of a PBM contract done by Pharmacy Outcomes Specialists, which represents companies, managed care organizations, unions and government agencies. The drugstore was reimbursed $10.83, so the PBM kept $10.77.
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